Spare me the few tired cliches about prostate cancer, diabetes, and sarcoidosis being more common in blacks than whites, or even the slightly increased risk of ACEI cough in patients of Asian descent. We screen Jews of Ashkenazi descent for Tay Sachs without any racial labeling. All that information is readily accessible under the Family History section of the medical history. It is no more than custom which dictates the standard introductory format including age, race, and gender. It turns out I’ve blogged about this before at some length (pretty good post, actually). What is new is the advent of electronic medical records.

Much hullabaloo has been made about federal stimulus funds allocated to doctors as payments for adopting EMRs; “up to $44,000!” Here’s the problem with that figure, though, including how it breaks down (source here): Read more »

People aren’t dumb. Even if — or maybe especially if — news stories don’t point out the limitations of observational studies and the fact that they can’t establish cause-and-effect, many readers seem to get it.

* “I love how an article starts with something positive and then slowly becomes a little gloomy. So is it good or not? I’m still where I was with coffee, it’s all in moderation, it ain’t gonna solve your health woes.”

* “The statistics book in a class I’m taking uses coffee as an example of statistics run amuck. It seems coffee has caused all the cancers and cures them at the same time.”Read more »

Writing about health care reform, Peggy Noonan complains of the decay of the English language:

A reporter asked a few clear and direct questions: What is President Obama’s health plan, how would it work, what would it look like? I leaned forward. Finally I would understand. [Secretary of Health and Human Services Kathleen] Sebelius began to answer in that dead and deadening governmental language that does not reveal or clarify, but instead wraps legitimate queries in clouds of words and sends them our way. I think I heard “accessing affordable quality health care,” “single payer plan vis-a-vis private multiparty insurers” and “key component of quality improvement.” . . . . As she spoke, I attempted a sort of simultaneous translation. . . . But I gave up. Then a thought crossed my mind: Maybe we’re supposed to give up! Maybe we’re supposed to be struck dumb, hypnotized by words and phrases that are aimed not at making things clearer but making them obscure and impenetrable. Maybe we’re not supposed to understand.

Noonan is on to something, but it’s not what she thinks. What she’s hearing is real-life language of our health care system from the people in charge of it. And it’s not just government officials who talk this way — Sebelius’ language is just as common in the private sector.

It reveals the deepening divide between how people talk about health care and what it really means to be sick. Noonan jokes that if Sebelius’ child were to get a high fever she might say “This unsustainable increase in body temperature requires immediate access to a local quality health-care facility,” instead of just “We have to go to the hospital.” But I don’t believe that.

When a loved one is sick, all the abstract ideas melt away. It becomes about trying to get help from a doctor, and a doctor doing his or her best to help.

You might think our health care system would be set up to make that process easier. But it isn’t.

Patients and doctors report in overwhelming numbers how dissatisfied they are with what they see as the interference of well-meaning insurers, governments and others.

You might also think that the reform conversation happening in Washington would have the doctor-patient relationship at the forefront. But it doesn’t.

What does all of this stuff mean? How do you talk about health care and not even use the word “doctor” or talk about “patients”? Worse, I’m not sure more than one or two of these even qualify as “principles” as that word is normally used. So what’s going on?

I don’t think anyone is trying to deceive anyone. Like Sebelius’ choice of words, the list is as much of a description of the problem as a solution to it. We don’t have a consensus of what is really important in health care, so we avoid the problem altogether by using vague language that everyone can support. What’s worrisome is that vague, abstract talk is almost certain to lead to vague, abstract solutions.

Before we try to reform health care, let’s first talk about it in plain, clear language.

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